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General NPI Number Information
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NPI Number | 1659196525
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Entity Type | Organization
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Legal Business Name | ROYALTY FAMILY HOME CARE
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 8128 W HERBERT AVE
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City | MILWAUKEE
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State | WI
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Zip | 53218
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Country | US
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Telephone | 414-614-7026
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Fax |
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Provider Business Mailing Address
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Address Line | 8128 W HERBERT AVE
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City | MILWAUKEE
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State | WI
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Zip | 53218
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Country | US
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Telephone | 414-614-7026
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Fax |
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Authorized Official
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Title or Position | OWNERS
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Name | JAMES, SIEDAH, BEV TILLMAN JR, WILLIS,BOSWELL
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Credential |
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Telephone | 414-779-7188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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